Individual
JACOB COCKERHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHNP
Contact information
Practice address
279 SUMMIT DR, WATERFORD, MI 48328-3364
(248) 745-4900
Mailing address
279 SUMMIT DR, WATERFORD, MI 48328-3364
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
4704315433
MI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
4704315433
MI
Other
Enumeration date
03/27/2017
Last updated
11/03/2022
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